Until recently, nontranssexual cross-dressers were generally labeled transvestites. This term is now considered appropriately applied only to people who put on the clothes of the other sex to achieve sexual arousal (Langstrom & Zucker, 2005). The sexual component of cross­dressing for these individuals distinguishes them from female impersonators who cross­dress to entertain, gay men who occasionally “go in drag" to attract men or as a kind of “camp" acting out, and transsexuals who, as we discussed in Chapter 5, cross-dress to obtain a partial sense of physical and emotional completeness rather than to achieve sexual arousal.

Transvestism comprises a range of behaviors. Some people prefer to don the entire garb of the other sex. This is often a solitary activity, occurring privately in their homes. Occa­sionally, a person may go out on the town while so attired, but this is unusual. In general, the cross-dressing is a momentary activity, producing sexual excitement that often cul­minates in gratification through masturbation or sex with a partner. In many cases of transvestism, a person becomes aroused by wearing only one garment, perhaps a pair of panties or a brassiere. Because this behavior has a strong element of fetishism (Freund et al., 1996), the American Psychiatric Association (2000) formalized the link between transvestism and fetishism by placing both conditions in the diagnostic category trans­vestic fetishism. A distinguishing feature of transvestic fetishism is that the clothing article is actually worn instead of just being viewed or fondled, as is the case with fetishism.

According to the American Psychiatric Association (2000), a diagnosis of transves­tic fetishism is appropriately applied to heterosexual males who experience significant psychological distress or impaired functioning as a result of recurrent sexual fantasies, urges, or behavior involving cross-dressing that persist for at least 6 months.

Today, many members of the transgendered community, who are increasingly gaining a voice in both the professional literature and the popular media, contend that cross­dressing is often an appropriate and legitimate source of sexual arousal and expression rather than an indicator of disordered behavior or psychological impairment. Conse­quently, they reject the label of transvestic fetishism and its implication of abnormality.

The diagnostic criteria previously outlined specify that transvestic fetishism is the sole province of heterosexual males. Apparently, it is usually men who are attracted to transvestic fetishism. This seems true of all contemporary societies for which we have data. However, a few isolated cases of women cross-dressing for sexual pleasure also appear in the clinical literature (V. Bullough & Bullough, 1993; Stoller, 1982).

Several studies of both clinical and nonclinical populations suggest that transvestic fetishism occurs primarily among married men with predominantly heterosexual orien­tations (Bullough & Bullough, 1997; Doctor & Prince, 1997).

As with fetishism and some other atypical behaviors, the development of transvestic fetishism often reveals a pattern of conditioning. Reinforcement, in the form of arousal and orgasm, may accompany cross-dressing activities at an early point in the develop­ment of sexual interest, as illustrated in the following anecdote:

When I was a kid, about 11 or 12, I was fascinated and excited by magazine pic­tures of women modeling undergarments. Masturbating while looking at these pictures was great. Later, I began to incorporate my mother’s underthings in my little masturbation rituals, at first just touching them with my free hand, and later putting them on and parading before the mirror while I did my handjob. Now, as an adult, I have numerous sexual encounters with women that are quite satisfying without the dress-up part. But I still occasionally do the dress – up when I’m alone, and I still find it quite exciting. (Authors’ files)